European journal of anaesthesiology
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Clinical Trial Controlled Clinical Trial
Heated humidification in major abdominal surgery.
The influence of heated humidification on body temperature and postoperative shivering was studied in 30 patients undergoing major intra-abdominal surgery. In the control group (I) the anaesthetic gases, administered in a non-rebreathing system, were humidified by a sponge heat and moisture exchanger. In group II the gases were humidified and heated to 37 degrees C and in group III up to 40 degrees C. ⋯ A good correlation was found between heat gain during the first hour of recovery, the feeling of cold and intensity of shivering. Intraoperative heat loss was minimal in all groups. Heated humidification had no statistically significant effect on the body temperatures or postoperative shivering and thus provided no additional advantage compared to the control group.
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A series of 52 patients in whom 0.5% bupivacaine was used to produce spinal analgesia for awake Caesarean section is described. Analgesia tended to be asymmetrical and of limited extent until the patients were turned from the left lateral to the right lateral position immediately after injecting the spinal solution. This movement produced a more symmetrical block with better cephalic spread. ⋯ The mean +/- SEM time to achieve maximal spread of analgesia was 17.5 +/- 0.6 min. The mean- +/- SEM time to the administration of the first postoperative analgesic was 163.5 +/- 7.0 min. The disadvantages of the technique were hypotension and the unpredictable spread of analgesia.
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Review Comparative Study
Multiple opioid receptor systems in brain and spinal cord: Part 2.
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The biological activity of opioid agents reflects their interaction with specific membrane sites. The fact that the drug interaction resulting in physiological responses shows distinguishing characteristics with regard to rank order of agonist potency, affinity of the antagonist for the site acted upon by the agent to produce the effect, tolerance and cross-tolerance, may be interpreted as indicating that different opioids produce their effects by an action on distinctive receptors. Examination of the literature provides support for the hypothesis proposed by different investigators that the physiological effects of the several opioid ligands may be parsimoniously explained in terms of several possibly overlapping receptor classes including mu, delta, kappa, sigma and epsilon. ⋯ Though not reviewed, it is likely that a similar complexity underlies the interaction of opioids with neural substrates mediating other functions. Thus different opioid receptors may modulate the same physiological phenomenon because they are on different systems which have a similar output (e.g. spinal reflex inhibition) or they may co-exist on the same neurone. In short, it appears likely that there are discriminable populations of opioid receptors and that no single receptor can be said to modulate a given physiological effect.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of phenoxybenzamine on postoperative urinary complications during extradural morphine analgesia.
One hundred and fifty patients, post-Caesarean section, were investigated to evaluate the effect of epidural morphine analgesia and that of phenoxybenzamine on the frequency and extent of urinary complications. Forty patients (group A) underwent Caesarian section under general anaesthesia, while 110 patients received epidural anaesthesia. Of the latter patients, 40 received postoperative mild analgesics (group B) whilst in another 40, postoperative continuous epidural morphine was administered (group C). ⋯ The need for bladder catheterization was also increased in group B compared with group A, while in group C this increase was marked compared with both groups A and B. It was significantly less frequent in those receiving phenoxybenzamine. Phenoxybenzamine is recommended in the prevention of postoperative urinary complications associated with epidural anaesthesia and epidural morphine analgesia.